One of the biggest trade-offs between Medicare Advantage and traditional Medicare is that Medicare Advantage plans have a more limited network of doctors and other providers. The size and breadth of provider networks can be an important factor for beneficiaries when choosing between traditional Medicare with a Supplement and Medicare Advantage plans. As of 2017, 19 million of the 58 million people on Medicare (33%) are enrolled in a Medicare Advantage plan, yet little is known about their provider networks. Remember 2014, UHC cut 10% of specialist doctors from its network.

Here are a few brief statistics on your Medicare Advantage plan:

1

More than three in ten (35%) Medicare Advantage enrollees are in narrow-network plans while about two in ten (22%) are in broad-network plans. To some degree, the relative narrowness of plan networks masks the total number of physicians that enrollees can access, particularly in larger counties.

2

Medicare Advantage networks include less than half (46%) of all physicians in a county, on average. If you are in a larger county or city, your network will be relatively larger than that of a small rural county.

3

Network size varies greatly among Medicare Advantage plans offered in a given county. For example, while enrollees in St. Louis County, MO, have access to a larger network of doctors, plans in Boone County, MO, have significantly fewer physicians in-network.

4

Access to psychiatrists are typically more restricted than for any other specialty. Medicare Advantage plans have 23% of the psychiatrists in a county, on average; 36% of plans include less than 10% of psychiatrists in their county. Some plans provide relatively little choice for other specialties as well; 20% of plans include less than 5 cardiothoracic surgeons, 18% of plans include less than 5 neurosurgeons, 16% of plans include less than 5 plastic surgeons, and 16% of plans include less than 5 radiation oncologists.

5

Broad-network plans tended to have higher average premiums than narrow-network plans, and this is true for both HMOs ($54 versus $4 per month) and PPOs ($100 versus $28 per month).

Insurers may create narrow networks for a variety of reasons, such as to have greater control over the costs and quality of care provided to enrollees in the plan. The size and composition of Medicare Advantage provider networks are likely to be particularly important to enrollees when they have an unforeseen medical event or serious illness. However, accessing the information may not be easy for users, and comparing networks could be especially challenging. Beneficiaries could unwittingly face significant costs if they accidentally go out-of-network. Differences across plans, including provider networks, pose challenges for Medicare beneficiaries in choosing among plans and in seeking care and highlight the importance of working with a reputable independent broker.

Even with these network restrictions and limitations, Medicare Advantage plans remain popular amongst clients. My job as an independent broker is to ensure clients that they select the most appropriate plan based on their specific needs.